The CMS Acute Hospital Care at Home (AHCAH) initiative lets an acute care hospital paid under the inpatient prospective payment system deliver inpatient-level care in patients' homes under CMS waivers of certain hospital Conditions of Participation, including two nursing-service requirements. It is for hospital systems launching or expanding home-based acute care, with the waivers and flexibilities extended through September 30, 2030, as CMS states. Integral Healthcare Solutions (IHS) drafts the hospital-at-home policies, escalation procedures and evidence system; your clinical leaders approve and run the care.

What is the Acute Hospital Care at Home waiver?

CMS's AHCAH data release fact sheet describes the initiative as “allowing individual hospitals to seek waivers of § 482.23(b) and (b)(1) of Medicare regulations (also known as "conditions of participation" (CoPs)).” Those two provisions are in 42 CFR § 482.23, as the fact sheet cites them. CMS explains what the waivers do: “These waivers suspended the requirements for a hospital's nursing services to be provided on premises 24 hours a day, 7 days a week, and for a registered nurse to be immediately available, respectively.”

The nursing-service waivers are not the only ones CMS describes. The fact sheet adds: “under section 1135 of the Act, the Secretary waived hospital ‘Physical Environment’ and ‘Life Safety Code’ CoPs in order to deliver care in the patient’s home.” It continues: “Hospitals providing care in patients homes continued to meet all health and safety requirements that were not waived through the PHE waiver authority under section 1135 of the Act.” CMS’s December 17, 2024 blog says hospitals “were and are still required to meet most health and safety requirements, even in the patient’s home.” This page does not list which provisions are waived beyond those CMS names; the fact sheet describes the waivers in the past tense, so confirm what is in force in CMS’s current waiver terms.

The extension has a statutory end date. Per the same fact sheet (dated March 17, 2026), “section 6210 of the Consolidated Appropriations Act, 2026 (P.L. 119-75) further extended waivers and flexibilities associated with the AHCAH initiative until September 30, 2030.” The initiative grew out of a wider pandemic program: “CMS initially launched the broader "Hospital Without Walls" initiative in March 2020.”

Who needs it and what triggers it

CMS's December 17, 2024 blog on lessons from the initiative says AHCAH “allowed acute care hospitals that are paid under the inpatient prospective payment system to expand their delivery of inpatient care into patients' homes.” The usual triggers are:

• A hospital deciding to launch a program, with CMS stating that the associated waivers and flexibilities run until September 30, 2030.
• A hospital with an approved waiver expanding the program to new conditions, sites or partners, which changes how it meets the health and safety requirements that were not waived.
• Preparing the waiver request itself. The blog states: “To participate in the AHCAH initiative, hospitals are required to submit a waiver request through a dedicated CMS portal. Following review, CMS meets with each requesting hospital to assess whether it can provide high-quality and safe care in home settings, compliant with the Medicare Hospital CoPs.”
• Ongoing monitoring. Per the fact sheet, “Every hospital participating in AHCAH agrees to ongoing monitoring – reporting critical safety and quality metrics to CMS either weekly or monthly depending on their experience level.”

How IHS helps

IHS treats a hospital-at-home program as a compliance build on top of the hospital's existing CoP program. The work runs in this order:

1. A gap assessment of your program design against the waiver terms and the hospital health and safety requirements CMS has not waived.
2. A responsibility crosswalk across the hospital and its partners, so each requirement has one owner and a named piece of evidence.
3. Drafting: program policies, clinical protocols for the program's physicians and nurses to approve, escalation and transfer procedures, vendor interface agreements and an evidence system that supports the monitoring CMS requires.
4. A mock review of the program against the CoPs and the waiver terms.
5. Drafted waiver request text for your hospital to review and submit through the CMS portal.

Your hospital supplies the program design, its clinical leaders, its vendor contracts and its current hospital policies.

The limit: acute clinical care design and in-home logistics are the hospital's. IHS drafts protocols for your physicians and nurses to approve and does not make clinical decisions. IHS has not run a hospital-at-home engagement before; it brings a CoP-based method, and your clinical team brings the operating experience. For the operating program around the care, see program development.

What to have ready

Each item ties to CMS's AHCAH data release fact sheet (March 17, 2026) or AHCAH blog (December 17, 2024), as published.

• Confirmation that your hospital is an acute care hospital paid under the inpatient prospective payment system, the hospitals the blog describes AHCAH as allowing to expand inpatient care into patients' homes (blog).
• A written description of how nursing services will work in the home without on-premises nursing 24 hours a day, 7 days a week and without a registered nurse immediately available, the two requirements the AHCAH waivers of 42 CFR § 482.23(b) and (b)(1) suspended (fact sheet).
• Your current hospital policies, mapped to the health and safety requirements that were not waived, since hospitals “continued to meet all health and safety requirements that were not waived through the PHE waiver authority under section 1135 of the Act” (fact sheet). Add the “Physical Environment” and “Life Safety Code” CoPs the fact sheet says the Secretary waived, checked against CMS's current waiver terms.
• Draft patient inclusion criteria. CMS notes that “Patient inclusion criteria were developed by each hospital, based on the hospital's experience and resource capabilities to provide inpatient-level care in the home environment” (blog).
• Your escalation and transfer procedures as they stand. CMS meets with each requesting hospital to assess whether it can provide high-quality and safe care in home settings (blog), and the fact sheet defines “patient escalations” as patients whose care involved a transfer from the home to the traditional inpatient setting.
• A named owner for the safety and quality metrics reported to CMS weekly or monthly, depending on the hospital's experience level (fact sheet). CMS's released data include new patients admitted to the home setting, patient escalations and unanticipated mortalities, as CMS defines them (fact sheet).
• A program calendar that records the extension date CMS states: section 6210 of the Consolidated Appropriations Act, 2026 (P.L. 119-75) extended the AHCAH waivers and flexibilities until September 30, 2030 (fact sheet).
• The person at your hospital who will submit the waiver request through the dedicated CMS portal (blog). CMS's portal pages did not show request materials when we reviewed them, so IHS drafts from what your hospital supplies.

How it compares

The comparison CMS itself draws is with the program AHCAH came from. “Hospital Without Walls” was the broader initiative CMS launched in March 2020 (fact sheet). AHCAH is the narrower, hospital-by-hospital initiative, with waivers of § 482.23(b) and (b)(1), whose associated waivers and flexibilities the Consolidated Appropriations Act, 2026 extended to September 30, 2030. Other ways to deliver care at home, such as home health or payer-run programs, run under different rules that this page does not cover; your clinical and finance leaders weigh them against your patient population.

What it costs

CMS does not publish a fee schedule on the pages we reviewed; fees depend on scope. Neither the fact sheet nor the blog states a fee for submitting a waiver request. IHS scopes each engagement after a free introductory call.

What this is not

• It is not legal advice. Statutory and reimbursement questions go to your counsel.
• It is not a guarantee that CMS will grant or continue a waiver. CMS reviews each request and meets with each hospital.
• IHS does not submit the waiver request or deal with CMS for you. IHS drafts; your hospital submits.

Frequently asked questions

What is the CMS Acute Hospital Care at Home waiver?

It is a CMS initiative that lets individual hospitals seek waivers of 42 CFR 482.23(b) and (b)(1), the nursing-service requirements that nursing be provided on premises 24 hours a day, 7 days a week and that a registered nurse be immediately available. With the waiver, a hospital can deliver inpatient-level care in patients' homes. CMS also states that, under section 1135 of the Act, the Secretary waived the hospital "Physical Environment" and "Life Safety Code" CoPs to deliver care in the patient's home, and that hospitals continued to meet all health and safety requirements that were not waived.

How long is the hospital-at-home waiver extended?

CMS's fact sheet of March 17, 2026 states that section 6210 of the Consolidated Appropriations Act, 2026 (P.L. 119-75) extended the waivers and flexibilities associated with the AHCAH initiative until September 30, 2030.

Which hospitals are eligible for Acute Hospital Care at Home?

CMS describes AHCAH as allowing acute care hospitals that are paid under the inpatient prospective payment system to expand their delivery of inpatient care into patients' homes. Each hospital requests its own waiver.

How does a hospital submit an AHCAH waiver request?

CMS states that hospitals submit a waiver request through a dedicated CMS portal. After review, CMS meets with each requesting hospital to assess whether it can provide high-quality and safe care in home settings, compliant with the Medicare Hospital Conditions of Participation. IHS can draft the request text; the hospital submits it.

Which Conditions of Participation are waived and which still apply at home?

CMS's fact sheet names the nursing-service provisions at 42 CFR 482.23(b) and (b)(1) and, under section 1135 of the Act, the "Physical Environment" and "Life Safety Code" CoPs. CMS states that hospitals providing care in patients' homes continued to meet all health and safety requirements that were not waived. This page does not list other waived provisions, so confirm what is in force in CMS's current waiver terms.

What safety and quality data must AHCAH hospitals report to CMS, and how often?

CMS states that every participating hospital agrees to ongoing monitoring, reporting critical safety and quality metrics to CMS either weekly or monthly depending on its experience level. The hospital needs a named owner and a reliable data source for each metric.

What do hospitals need in place before CMS approves a waiver?

CMS meets with each requesting hospital to assess whether it can provide high-quality and safe care at home in compliance with the hospital Conditions of Participation. CMS also notes that each hospital developed its own patient inclusion criteria based on its experience and resources. The specific request requirements are in the current CMS request materials, which the hospital obtains through the portal.

How long does CMS take to review a waiver request?

CMS does not publish a review timeline on the pages we reviewed. Plan the program launch around the CMS meeting and review rather than a fixed date.